Antimicrobial Resistance Surveillance Latin America

Microbiology laboratories: from routine clinical work to

surveillance

The Latin American AMR Surveillance Network Focus: quality control in bacteriology & antimicrobial resistance

GUATEMALA

NICARAGUAEL SALVADOR

ECUADOR

PERU

BOLIVIA

PARAGUAYSupra national laboratories:INEI CG Malbran (ARGENTINA)

Enteropathogens Lab (CANADA)

Coordination

PAHO/WHO

COSTA RICAHONDURAS

PANAMADOMINICAN REPUBLIC

VENEZUELAURUGUAY

CHILE

2000

2002

2003

MEXICOCOLOMBIABRAZILCUBA2

005 2011 TRINIDAD & TOBAGO

2013 THE BAHAMAS (?)

Pathogens under surveillance

Nosocomial pathogens• Enterococcus spp.• Klebsiella pneumoniae• Acinetobacter spp.• Pseudomonas

aeruginosa• Staphylococcus aureus• Escherichia coli• Enterobacter spp.

Community pathogens• Salmonella spp.• Shigella spp.• Vibrio cholerae • Escherichia coli• Neisseria meningitidis• Neisseria gonorrhoeae• Streptococcus

pneumoniae• H. influenzae• Campylobacter• S. β hemolítico• S. aureus

CLSI Standards for susceptibility testing

Latin American AMR Surveillance Network (2012)

WHONET

Information System

Nat. Reference Labs

Data reporting to the NRL

20 National

Reference Labs 720 Centinel Labs

175,000 isolates

National Microbiology Laboratory for Enteric Pathogens, Canada

Instituto Nacional de Enfermedades Infecciosas, C. Malbrán, ANLIS, Argentina

Standardization and quality

1. Manuals for quality assurance & Training activities

2. Biennial Meeting 3. Annual Report

Common quality standardsCLSI Spanish translation

Susceptibiliy Testing Correlation

% Concordancia

Enc 1 Enc 2 Enc 3 Enc 4 Enc 5 Enc 6 Enc 7 Enc 8 Enc 9 Enc 10Enc 11Enc 12Enc 13Enc 14Enc 15 Enc 16Enc 170

20

40

60

80

100 IDEAL 90%

Source: Alejandra Corso, INEI ANLIS Dr. Carlo G. Malbran, Argentina

QUALITY EVOLUTION INDICATORS OF THE LATIN AMERICAN

COUNTRIES

Annual Reports

10

Methicillin Resistant Staphylococcus aureus(hospital isolates)

Latin America AMR Surveillance Network, 2000 - 2005

Escherichia coli Ciprofloxacin resistance

The Latin American AMR Surveillance Network, 2000-2005

Klebsiella spp Imipenem resistance

The Latin American AMR Surveillance Network, 2000-2007

Carbapenemases (KPC & NDM)2013

Title of the Presentation13

Promotion of the rational use of antimicrobials

Epidemiological Alerts

KPC Argentina 2010

NDM Guatemala 2011

Guatemala

Roosvelt Hospital, Guatemala City733 beds

High-complexity hospital

- MRSA- IMP-resistant A.

baumanii- IMP-resistant P.

aeruginosa - ESBL + K.

pneumoniae

0

2

4

6

8

10

12

14

16

18

S. aureus A. baumannii P. aeruginosa K.pneumoniae

Thousands (U

S$)

S

R

Cost of treating HAIs caused by multi-resistant bacteria

MRSA

IMP-RIMP-R

ESBL

Guatemala

Roosvelt Hospital, Guatemala City733 beds

High-complexity hospital

- MRSA- IMP-resistant A.

baumanii- IMP-resistant P.

aeruginosa - ESBL + K.

pneumoniae

0

2

4

6

8

10

12

14

16

18

S. aureus A. baumannii P. aeruginosa K.pneumoniae

Thousands (U

S$)

S

R

Cost of treating HAIs caused by multi-resistant bacteria

MRSA

IMP-RIMP-R

ESBL

Conclusion & Challenges

• The LAC network has facilitated an extraordinary improvement in the quality of the laboratories, but still challenges are ahead:• Improve the quality of data (representative data

and ensure validity of laboratory results)• Foster analysis and publication of results at

country level• Use of the information:

• Advocacy at national level• Strengthening the regional and national initiatives

for rational use of antibiotics

Challenges

• Continuos improvement of the quality of the laboratories• Timely dissemination of information• Molecular biology

• Linking surveillance & AMR containment

The basics and the bases to start AMR and HAI surveillance

1. Agreement on the goal & main activities of the surveillance

2. Need of technical coordination 3. Communication mechanisms and

commitments among the members of the network

4. Agreement on relevant partners and its role

5. Define the operational / technical details